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General NPI Number Information
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NPI Number | 1053791160
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Entity Type | Individual
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Provider Name | LAUREN NICOLE SHELDON ATC
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Gender | Female
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 17828 SW STATE ROAD 47
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City | FORT WHITE
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State | FL
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Zip | 32038-3602
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Country | US
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Telephone | 860-933-8089
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Fax |
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Provider Business Mailing Address
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Address Line | 447 WOODLAND RD
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City | STORRS
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State | CT
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Zip | 06268-1401
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Country | US
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Telephone | 860-933-8089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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